Meta‐analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis. BJS 2019; 106: 1442-1451.
Published: 3rd July 2019
Authors: N. Moody, A. Adiamah, F. Yanni, D. Gomez
Gallstones account for 30–50 per cent of all presentations of acute pancreatitis. While the management of acute pancreatitis is usually supportive, definitive treatment of gallstone pancreatitis is cholecystectomy. Guidelines from the British Society of Gastroenterology suggest definitive treatment on index admission or within 2 weeks of discharge, whereas joint recommendations from the International Association of Pancreatology and the American Pancreatic Association recommend definitive treatment on index admission. Evidence suggests that uptake of these guidelines is low.
Embase, MEDLINE and Cochrane databases were searched for RCTs investigating early versus delayed cholecystectomy in patients with a confirmed diagnosis of mild gallstone pancreatitis. The pooled synthesis was undertaken using a random‐effects meta‐analysis of the primary outcome of recurrent biliary complications causing hospital readmission. Secondary outcomes included intraoperative and postoperative complications, and total length of hospital stay (LOS). All analyses were performed using RevMan5 software.
Five RCTs were identified, which included 629 patients (318 in the early cholecystectomy (EC) group and 311 in the delayed cholecystectomy (DC) group). Recurrent biliary events that required readmission were reduced in patients undergoing EC compared with the number in patients having DC (odds ratio (OR) 0·17, 95 per cent c.i. 0·09 to 0·33). There was no difference in the rate of intraoperative (OR 0·58, 0·17 to 1·92) or postoperative (OR 0·78, 0·38 to 1·62) complications.
EC following mild gallstone pancreatitis does not increase the risk of intraoperative or postoperative complications, but reduces the readmission rate for recurrent biliary complications.Full text
You may also be interested in
Randomized clinical trial
Phase II randomized clinical trial of endosonography and PET/CT versus clinical assessment only for follow‐up after surgery for upper gastrointestinal cancer (EUFURO study).
Authors: O. S. Bjerring, C. W. Fristrup, P. Pfeiffer, L. Lundell, M. B. Mortensen
Short‐term medical treatment of hypercalcaemia in primary hyperparathyroidism predicts symptomatic response after parathyroidectomy.
Authors: A. Koman, S. Ohlsson, R. Bränström, Y. Pernow, R. Bränström, I.‐L. Nilsson et al.
Development and evaluation of the General Surgery Objective Structured Assessment of Technical Skill (GOSATS).
Authors: Y. Halwani, A. K. Sachdeva, L. Satterthwaite, S. de Montbrun
Randomized controlled trial of plain English and visual abstracts for disseminating surgical research via social media.
Authors: S. J. Chapman, R. C. Grossman, M. E. B. FitzPatrick, R. R. W. Brady
Randomized clinical trial
Randomized clinical trial of extensive intraoperative peritoneal lavage versus standard treatment for resectable advanced gastric cancer (CCOG 1102 trial).
Authors: K. Misawa, Y. Mochizuki, M. Sakai, H. Teramoto, D. Morimoto, H. Nakayama et al.
Authors: H. K. James, A. W. Chapman, G. T. R. Pattison, D. R. Griffin, J. D. Fisher
Network meta‐analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia.
Authors: J. H. H. Olsen, S. Öberg, K. Andresen, T. W. Klausen, J. Rosenberg
Effect of donor nephrectomy time during circulatory‐dead donor kidney retrieval on transplant graft failure.
Authors: L. Heylen, J. Pirenne, U. Samuel, I. Tieken, M. Coemans, M. Naesens et al.
Authors: C. A. Sewalt, E. Venema, E. J. A. Wiegers, F. E. Lecky, S. C. E. Schuit, D. den Hartog et al.
Authors: L. Scholten, T. F. Stoop, M. Del Chiaro, O. R. Busch, C. van Eijck, I. Q. Molenaar et al.
Authors: L. Cairncross, H. A. Snow, D. C. Strauss, M. J. F. Smith, O. Sjokvist, C. Messiou et al.